A randomised prospective comparison of percutaneous endoscopic gastrostomy and nasogastric tube feeding after acute dysphagic stroke

Abstract

Objective : To compare percutaneous endoscopic gastrostomy and nasogastric tube feeding after acute dysphagic stroke. Design : Randomised prospective study of inpatients with acute stroke requiring enteral nutrition. Setting : One university hospital (Nottingham) and one district general hospital (Derby). Subjects : 30 patients with persisting dysphagia at 14 days after acute stroke: 16 patients were randomised to gastrostomy tube feeding and 14 to nasogastric tube feeding. Main outcome measures : Six week mortality; amount of feed administered; change in nutritional state; treatment failure; and length of hospital stay. Results : Mortality at 6 weeks was significantly lower in the gastrostomy group with two deaths (12%) compared with eight deaths (57%) in the nasogastric group (P<0.05). All gastrostomy fed patients (16) received the total prescribed feed whereas 10/14 (71%) of nasogastric patients lost at least one day's feed. Nasogastric patients received a significantly (P<0.001) smaller proportion of their prescribed feed (78%; 95% confidence interval 63% to 94%) compared with the gastrostomy group (100%). Patients fed via a gastrostomy tube showed greater improvement in nutritional state, according to several different criteria at six weeks compared with the nasogastric group. In the gastrostomy group the mean albumin concentration increased from 27.1 g/l (24.5 g/l to 29.7 g/l) to 30.1 g/l (28.3 g/l to 31.9 g/l). In contrast, among the nasogastric group there was a reduction from 31.4 g/l (28.6 g/l to 34.2 g/l) to 22.3 g/l (20.7 g/l to 23.9 g/l) (P<0.003). In addition, there were fewer treatment failures in the gastrostomy group (0/16 versus 3/14). Six patients from the gastrostomy group were discharged from hospital within six weeks of the procedure compared with none from the nasogastric group (P<0.05). Conclusion : This study indicates that early gastrostomy tube feeding is greatly superior to nasogastric tube feeding and should be the nutritional treatment of choice for patients with acute dysphagic stroke. Key messages: Key messages Patients fed through a gastrostomy are more likely to receive more of their prescribed feed and show a greater improvement in nutritional state Gastrostomy tube feeding is associated with fewer treatment failures Patients fed through a gastrostomy are more likely to be discharged earlier from hospital Gastrostomy feeding is superior to nasogastric tube feeding after acute dysphagic stroke